Project Overview +

Peer mentoring and support models have been found in two recent VA RCTs to be more effective than usual care, financial incentives, and usual nurse care management to improve glycemic control in high-risk veteran patients with poor glycemic control.

While peer supporters and coaches can be trained in effective behavioral approaches to support other veteransí self-management behaviors, such supporters necessarily lack content expertise to help veterans better share in treatment decisions and goal-setting with their health care providers.

Accordingly, in an AHRQ-supported RCT we developed and tested tailored, interactive tools with diabetes and medication information embedded in the tool software that peer coaches and other outreach workers can employ to facilitate discussions with patients. Such tools could enhance the sustainability and effectiveness of coaching programs to better prepare patients to set self-management goals, action plans, and to discuss treatment options with their health care providers.

Aims +

Aim 1. Test the effectiveness of a technology-enhanced peer coaching (TEC) program in improving glucose control relative to usual care. 

Aim 2. Assess the impact of the intervention on key patient-centered outcomes, including patientsí satisfaction with care, perceived social support, diabetes-specific quality of life, and self-care behaviors related to glycemic control.

Aim 3. Identify patient characteristics associated with willingness to participate in the intervention and mediators and moderators of the interventionís impact on patient outcomes.

Aim 4. Assess the cost-effectiveness of the program in improving glucose control.

Participants +

Diabetes patients with poor glycemic control from the Detroit VA Medical Center.

Intervention +

Patients are recruited from the Detroit VA Medical Center and randomized to either the technology-enhanced peer coaching (TEC) program or to usual care.

In the TEC program, participants are assigned to one of 30-40 peer coaches, who also are Detroit VA diabetes patients who previously had poor glycemic control but are currently in good control. Peer coaches undergo training in motivational interviewing-based counseling approaches and instruction in use of the tailored interactive diabetes and diabetes medication decision aid tool that has been adapted for the VA. 

The coach goes through the decision aid tool with them, lists questions and concerns they wish to discuss with their health care provider, helps them practice raising their questions and concerns, and helps them develop an action plan to address barriers to self-management they have identified. Facilitated by an interactive voice response (IVR) phone system, the peer mentors call their assigned peers at least once a week to provide support for their action steps.

The primary endpoint is HbA1c levels at 6 months. Secondary endpoints include other physiological measures and patient-centered outcomes, measured at both 6 and 12 months.

Technologically Enhanced Coaching (TEC): A Program for Improving Diabetes Outcomes

09/01/2013 - 08/31/2017

Sponsor(s)

Department of Veterans Affairs

Principal Investigator:

M. E. Michele Heisler, MD, MPA